Role of Geography on Alzheimer’s Disease and Related Dementias in Central Appalachia

地理对阿巴拉契亚中部阿尔茨海默病和相关痴呆症的影响

• 批准号: 10509690
• 负责人: Jeffrey James Wing
• 金额: $ 7.4万
• 依托单位: OHIO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-15 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10509690
• 关键词: Address; Age; Alzheimer' s Disease; Alzheimer' s disease diagnosis; Alzheimer' s disease related dementia; Alzheimer' s disease risk; American; American Medical Association; Appalachian Region; Area; Attenuated; Automobile Driving; Binomial Model; Caring; Censuses; Characteristics; Community Surveys; Country; County; Data; Data Aggregation; Data Set; Data Sources; Dementia; Detection; Diagnosis; Diagnostic; Disease; Education; Ethnic Origin; Geographic Locations; Geography; Health Services Accessibility; High Prevalence; Housing; Image; Incidence; Intervention; Investigation; Lead; Measures; Modeling; Neurologist; Ohio; Pattern; Patterns of Care; Policies; Population; Prevalence; Primary Care Physician; Principal Investigator; Proxy; Publishing; Race; Reporting; Research Personnel; Resources; Role; Rural; Rural Appalachia; Scanning; United States Centers for Medicare and Medicaid Services; Variant; Work; beneficiary; burden of illness; comorbidity; data resource; demographics; experience; geographic difference; geographic disparity; health care quality; health care service; improved; innovation; multiple data sources; prognostic; programs; racial and ethnic; regional difference; rural area; rural counties; rural dwellers; sociodemographic factors; sociodemographics; urban area

Project Summary/Abstract Geographic variation in Alzheimer’s disease and related dementias (ADRD) prevalence exists, but the mechanisms driving these disparities remain unknown. The two most likely and non-exclusive explanations for geographic variation in ADRD are: 1. disparities in patterning of sociodemographic factors (e.g. rural residents may be at a greater risk of ADRD due to lower educational attainment) and/or 2. differences in disease detection rates (e.g. rural residents may have reduced access to and quality of health care services and thus fewer dementia diagnoses regardless of the true prevalence). As rural areas have lower reported ADRD prevalence compared to urban areas in spite of lower educational attainment (which should lead to higher ADRD prevalence) this argues that the true burden of ADRD in likely underestimated in areas without adequate detection resources. There is need to understand if ADRD prevalence is truly lower in rural areas, or if this is a disease detection difference. The objective of this proposal is to assess the burden of ADRD in Central Appalachia. By using geographic characteristics to assess the association between geographic variation, socio-demographic factors, and access to care (e.g. primary care physicians (PCPs), neurologists) we will understand how patterns of care influence ADRD diagnoses and which parts of the country may have relatively over- or underestimated ADRD prevalence due to differences in care intensity. 1. We will verify regional differences in ADRD prevalence across the Central Appalachian region using stratified negative binomial regression models. Working hypothesis: Rural counties will have lower ADRD prevalence, as will Appalachian counties relative to urban and non-Appalachian counties, respectively. 2. Socio-demographic and access to care factors will be included in existing negative binomial models to assess their contribution to regional differences in ADRD prevalence. Working hypothesis: socio-demographic and access factors partially explain/attenuate variations in ADRD prevalence. This proposal addresses the objectives of PAS-19-391 in several ways: 1. The Principal Investigator (PI) is an early stage investigator committed to ADRD; 2. The PI has experience with using CMS data, census data, and other existing aggregate data sources; and 3. The PI has published using these data in describing geographic differences in ADRD prevalence in Ohio. This project would represent the next step in better understanding of regional differences in ADRD prevalence and provide critical data toward the role of access to care in estimating ADRD prevalence.

项目摘要/摘要 存在阿尔茨海默氏病和相关痴呆症（ADRD）患病率的地理差异，但 驱动这些差异的机制仍然未知。这两个最有可能的解释 ADRD的地理差异为：1。社会人口统计学因素模式的差异（例如，农村居民 由于受教育程度较低，可能面临更大的ADRD风险）和/或2。 检测率（例如，农村居民可能降低了获得和质量的医疗保健服务，因此 不论真正的患病率如何，痴呆症的诊断较少）。由于粗糙区域的报道较低 尽管受教育程度较低，但与城市地区相比，患病率（这应该导致更高 ADRD患病率）这一论点是，Adrd的真正燃烧可能被低估了 足够的检测资源。需要了解农村地区的ADRD患病率是否确实较低，还是 如果这是疾病检测差异。该提议的目的是评估ADRD的燃烧 中央阿巴拉契亚。通过使用地理特征来评估地理之间的关联 变异，社会人口统计学因素和获得护理的机会（例如，初级保健医生（PCP），神经科医生） 我们将了解护理模式如何影响ADRD诊断，以及该国哪些地区 由于护理强度的差异，相对过度或低估的ADRD患病率。 1。我们将验证 阿巴拉契亚中部地区的ADRD患病率使用分层负面 二项式回归模型。工作假设：农村县的流行率将较低，这也将 阿巴拉契亚县分别相对于城市和非阿帕拉奇县。 2。社会人口统计学和 现有的负二项式模型将包括在内的护理因素，以评估其对 ADRD患病率的区域差异。工作假设：社会人口统计学和访问因素部分 解释/衰减ADRD患病率的变化。该提案解决了PAS-19-391的目标 几种方法：1。主要研究人员（PI）是致力于ADRD的早期阶段调查员； 2。pi 具有使用CMS数据，人口普查数据和其他现有的汇总数据源方面的经验；和3。 已经使用这些数据发表了描述俄亥俄州ADRD患病率的地理差异。这个项目 将代表更好地理解ADRD患病率区域差异的下一步 关键数据朝着访问护理在估计ADRD患病率中的作用。